Cultura

A Multidisciplinary Healthcare Framework: Emergency Medicine, Paramedicine, Operating Room Technology, Psychiatry, and Health Information Systems

VOLUME 22, 2025

The Role of Targeted Infra-popliteal Endovascular Angioplasty to Treat Diabetic Foot Ulcers Using the Angiosome Model: A Systematic Review

VOLUME 6, 2023

Sultan Salem Attaq Alharbi, Mohammed Hijris Dharman Aldawsari, Mahdi Hasan Mahdi Al Kastaban, Abdullah Awad Abdullah Al-Harbi, Naif Nuhayr Nadi Alanazi, Abdullah Fahad Nasser Alsubiae, Sultan Salman Homoud Almatrafi
Abdulrahman Mohammed Rushoud Almutlag, Mohammed Ammash Barjas Almasari, Majed Ayedh alharbi, Badr Jaza Alamri, Rabeah Mobarak Aldossary, Ebtesam Basheer Alenzi, Mohammed Nazal Fahad Alanazi

Abstract

This study presents a comprehensive multidisciplinary framework integrating emergency medicine, paramedicine, operating room technology, psychiatry, and health information systems to address complex patient needs across the care continuum. Contemporary healthcare faces significant challenges including fragmentation of care, rising costs, increasing patient complexity, and workforce shortages that cannot be effectively addressed through single-discipline approaches. The framework outlined here emphasizes coordinated responses to high-acuity events, streamlined transitions between care environments, and information continuity throughout the patient journey. Key elements include: shared protocols and communication systems; integrated health information infrastructure; interprofessional education and training; coordinated response systems for specific clinical scenarios; and collaborative quality improvement initiatives. The framework's application is demonstrated through detailed clinical scenarios involving major trauma management, psychiatric emergencies with medical complications, and disaster response. Implementation challenges include professional silos, communication barriers, technological limitations, resource constraints, and regulatory complexity. However, promising solutions emerge through interprofessional education, technological advances in interoperability, and alternative payment models that reward coordinated care. By leveraging the complementary expertise of these disciplines within a structured framework, healthcare systems can enhance care quality, improve patient outcomes, and increase operational efficiency in service of the Institute for Healthcare Improvement's Triple Aim of improved patient experience, improved population health, and reduced costs.

Keywords : .
Erin Saricilar
Lecture in accounting. University of Basrah, College of Administration and Economics, Department of Accounting.

Abstract

Atherosclerotic disease significantly impacts patients with type 2 diabetes, who often present with recalcitrant peripheral ulcers. The angiosome model of the foot presents an opportunity to perform direct angiosome-targeted endovascular interventions to maximise both wound healing and limb salvage. A systematic review was performed, with 17 studies included in the final review. Below-the-knee endovascular interventions present significant technical challenges, with technical success depending on the length of lesion being treated and the number of angiosomes that require treatment. Wound healing was significantly improved with direct angiosome-targeted angioplasty, as was limb salvage, with a significant increase in survival without major amputation. Indirect angioplasty, where the intervention is applied to collateral vessels to the angiosomes, yielded similar results to direct angiosome-targeted angioplasty. Applying the angiosome model of the foot in direct angiosome-targeted angioplasty improves outcomes for patients with recalcitrant diabetic foot ulcers in terms of primary wound healing, mean time for complete wound healing and major amputation-free survival.
Keywords : Diabetic foot ulcer, angiosome, angioplasty